Self-Rated Health and Ability to Climb Stairs: A Pragmatic Health Assessment Before Lung Cancer Screening
Authors: Alison S. Rustagi, Christopher G. Slatore, Salomeh Keyhani
Journal: Annals of Internal Medicine (2023)

Ideas and OpinionsApril 2023Self-Rated Health and Ability to Climb Stairs: A Pragmatic Health Assessment Before Lung Cancer ScreeningAlison S. Rustagi, MD, PhD, Christopher G. Slatore, MD, MS, and Salomeh Keyhani, MD, MPHAlison S. Rustagi, MD, PhDDivision of General Internal Medicine, Medical Service, San Francisco Veterans Affairs Health Care System, and Department of Medicine, University of California-San Francisco, San Francisco, California (A.S.R., S.K.)Search for more papers by this author, Christopher G. Slatore, MD, MSNational Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC, and Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon (C.G.S.).Search for more papers by this author, and Salomeh Keyhani, MD, MPHDivision of General Internal Medicine, Medical Service, San Francisco Veterans Affairs Health Care System, and Department of Medicine, University of California-San Francisco, San Francisco, California (A.S.R., S.K.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M22-3598 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Lung cancer screening (LCS) prevents lung cancer death for persons in good health. Two randomized controlled trials (RCTs) were powered to detect a mortality benefit from LCS: the NLST (National Lung Screening Trial) (1) and the NELSON (Nederlands–Leuvens Longkanker Screenings Onderzoek) trial (2). These trials included only persons healthy enough for lung surgery, because the mortality benefit of LCS is attributed to surgical cure of early disease, and because competing causes of death could overwhelm any benefit of early lung cancer detection. Poor health may lessen the benefit of LCS by limiting surgical treatment or procedures to obtain tissue to ...References1. Aberle DR, Adams AM, Berg CD, et al; National Lung Screening Trial Research Team. Reduced lung-cancer mortality with low-dose computed tomographic screening. N Engl J Med. 2011;365:395-409. [PMID: 21714641] doi:10.1056/NEJMoa1102873 CrossrefMedlineGoogle Scholar2. de Koning HJ, van der Aalst CM, de Jong PA, et al. Reduced lung-cancer mortality with volume CT screening in a randomized trial. N Engl J Med. 2020;382:503-513. [PMID: 31995683] doi:10.1056/NEJMoa1911793 CrossrefMedlineGoogle Scholar3. Silvestri GA, Goldman L, Burleson J, et al. Characteristics of persons screened for lung cancer in the United States. A cohort study. Ann Intern Med. 2022;175:1501-1505. [PMID: 36215712] doi:10.7326/M22-1325 LinkGoogle Scholar4. Rustagi AS, Byers AL, Keyhani S. Likelihood of lung cancer screening by poor health status and race and ethnicity in US adults, 2017 to 2020. JAMA Netw Open. 2022;5:e225318. [PMID: 35357450] doi:10.1001/jamanetworkopen.2022.5318 CrossrefMedlineGoogle Scholar5. Vachani A, Carroll NM, Simoff MJ, et al. Stage migration and lung cancer incidence after initiation of low-dose computed tomography screening. J Thorac Oncol. 2022;17:1355-1364. [PMID: 36087860] doi:10.1016/j.jtho.2022.08.011 CrossrefMedlineGoogle Scholar6. Jonas D, Reuland D, Reddy S. Screening for lung cancer with low-dose computed tomography: an evidence review for the U.S. Preventive Services Task Force. Evidence Synthesis No. 198. AHRQ Publication No. 20-05266-EF-1. 2021. Accessed at www.uspreventiveservicestaskforce.org/uspstf/document/final-evidence-review/lung-cancer-screening on 14 January 2023. Google Scholar7. Rivera MP, Tanner NT, Silvestri GA, et al; American Thoracic Society Assembly on Thoracic Oncology. Incorporating coexisting chronic illness into decisions about patient selection for lung cancer screening. an official American Thoracic Society research statement. Am J Respir Crit Care Med. 2018;198:e3-e13. [PMID: 30004250] doi:10.1164/rccm.201805-0986ST CrossrefMedlineGoogle Scholar8. Arias E, Xu J. United States Life Tables, 2019. Division of Vital Statistics. 2022. Accessed at www.cdc.gov/nchs/data/nvsr/nvsr70/nvsr70-19.pdf on 3 November 2022. Google Scholar9. Meza R, Jeon J, Toumazis I, et al. Evaluation of the benefits and harms of lung cancer screening with low-dose computed tomography: modeling study for the US Preventive Services Task Force. JAMA. 2021;325:988-997. [PMID: 33687469] doi:10.1001/jama.2021.1077 CrossrefMedlineGoogle Scholar10. Cheung LC, Berg CD, Castle PE, et al. Life-gained-based versus risk-based selection of smokers for lung cancer screening. Ann Intern Med. 2019;171:623-632. [PMID: 31634914] doi:10.7326/M19-1263 LinkGoogle Scholar Author, Article, and Disclosure InformationAuthors: Alison S. Rustagi, MD, PhD; Christopher G. Slatore, MD, MS; Salomeh Keyhani, MD, MPHAffiliations: Division of General Internal Medicine, Medical Service, San Francisco Veterans Affairs Health Care System, and Department of Medicine, University of California-San Francisco, San Francisco, California (A.S.R., S.K.)National Center for Lung Cancer Screening, Veterans Health Administration, Washington, DC, and Center to Improve Veteran Involvement in Care, VA Portland Health Care System, Portland, Oregon (C.G.S.).Acknowledgment: The authors thank Francis Julian Graham, BA, for assistance reviewing trial criteria and guidelines.Financial Support: Dr. Rustagi received support from UCSF Resource Allocation Portal (#7710-138339-7500274-45). Dr. Slatore is supported by resources from the Veterans Affairs Portland Health Care System. The funders had no role in the design or conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M22-3598.Corresponding Author: Alison S. Rustagi, MD, 4150 Clement Street Mail Code 111A1 T-31, San Francisco, CA 94121; e-mail, alison.[email protected].edu.Author Contributions: Conception and design: S. Keyhani, A.S. Rustagi, C.G. Slatore.Analysis and interpretation of the data: A.S. Rustagi.Drafting of the article: A.S. Rustagi.Critical revision for important intellectual content: S. Keyhani, A.S. Rustagi, C.G. Slatore.Final approval of the article: S. Keyhani, A.S. Rustagi, C.G. Slatore.Obtaining of funding: A.S. Rustagi.Administrative, technical, or logistic support: S. Keyhani, A.S. Rustagi.Collection and assembly of data: A.S. Rustagi.This article was published at Annals.org on 7 March 2023. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics April 2023Volume 176, Issue 4Page: 568-571KeywordsCancer screeningHealth screeningLife expectancyLung and intrathoracic tumorsLung cancer screeningRandomized trials ePublished: 7 March 2023 Issue Published: April 2023 PDF downloadLoading ...